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Building Permit Applicat'o ri n 1 n 0_, /�
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Fire Protection System OFFICE USE onL\
City of Tigard . *- g '''4�a„i Received 1� Permit No":r ..4,
i , 10
INI
i4 Date/B : i
13125 SW Hall Blvd.,Tigard,OR 972/3 , Plan Review o A
C Phone: 503.718.2439 Fax: 503.598.1960 � Date/B : / Other Permit:
T 1 G A R l) Inspection Line: 503.639.4175 i l l; t« 0 2111 Date Ready/By: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: � , Supplemental Information
., TYPE OF i N l S I(Th ins REQUIR AIA•1-AND 2-FAMILY 68YELLING
❑New construction 0 Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
0 1-and 2-family dwellingValuation: $ j
0Commercial/industrial
❑Accessory building ❑Multi-family Number of bedrooms:
0 Master builder El Other: Number of bathrooms:
;SOB SITE INFOItMA 'ION AND LOCATION ,' Total number of floors:
Job site address: v Si-.to .,., 4.riAS New dwelling area: square feet
City/State/ZIP: l ,s 1�Ycl i c `) 773 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
® mEI;<t y ommo RC SR/HEC IS'T
* ,,ti
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
s 3 , work indicated on this application.
4 Valuation: $
.1 f/ Existing building area: square feet
New building area: square feet
VPROPER7 `:a :._ ,= TEN ': Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
'*fr6/Ni " "nix' 0 CONTi T,PERSON , r` TIOTI " '` r.
Business name: 0.G --c.vtw All contractors and subcontractors are required to be
Contact name: -�/�+ licensed with the Oregon Construction Contractors Board
V(Jt 1 l `6�""�� under ORS 701 and may be required to be licensed in the
Address: 5 ini -14,1.5, jurisdiction in which work is being performed.If the
City/State/ZIP: applicant is exempt from licensing,the following reasons
Y k�vr i a QZ. `i }ZZ 3 apply:
Phone:( 7j ) 1py—X31;1 Fax::( )
E-mail: J .TGffr�rwr�y r ..,;rt
,.� s; •,. CONi'RAC .. "i:"— ,, H o ...8 G PERMIT FEE * 1
Business name: e refer fee schedule m.
�1l/Vr' Permit fee:
Address:
State surcharge(12%of permit fee):
City/State/Z1P:
FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) (Due upon application submittal.)
CCB lie.: Total permit fees:
Amount received:
Authorized signature: ---/?,( ''—
ignature: <' —:?2--ii------
'J
/ This permit application expires if a permit is not obtained
,7 Date: ' � y
within 180 days after it has been accepted as complete.
Print name:
-L-'13),,,,,,_ t�"/+`�b� ( , * Fee methodology set by Tri-County Building Industry
Service Board.
I.\Building\Permits\FPS-PemtitApp_031016.doc 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done:
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
I=1New system Number of sprinkler heads: Number of alarm devices:
El Addition or El 1-10 heads: Affidavit required and El 1-5 devices: Affidavit required and
Alteration (3) copies of sketch showing area (3) copies of sketch showing area
to existing of work within building structure of work within building structure
system
❑ 11+ heads: Plan review required and ❑ 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
T`y a of System (C mplete A,B O-orD as-a le):
inFcial Spee Mx
Sprinkler Type ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B) eI - Iia r. aS p s i i yst .. ....
Hood Project Valuation: $
C} W ire .tin
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
D.) ' : al Sp�a ` er(Stan, :e`System)
Square Footage: Permit Fee: Y °
0 to 2,000 $198.754' ..3
0-4
2,001 to 3,600
$246.45 "' � �x
3,601 to 7,200 $310.05 7 ,Z."=7.97;t7
7,201 and greater $404.39
Sprinkler Project Square Footage: sq. ft.
cton Permit Fees : . :
Project valuation subtotal (see A,B &C above): $
Permit fee based on project valuation (see fee schedule): $
Permit fee based on square footage (see D above): $
State Surcharge (12%of permit fee): $
FLS Plan Review(40% of permit fee): $
TOTAL: $
I:\Building\Permits\FPS_PermitApp_031016.doc 2
Dianna Howse
From: Dianna Howse
Sent: Wednesday, August 29, 2018 4:34 PM
To: jthornton@madronarecovery.com
Cc: #Building Permit Technicians;Tom Hochstatter
Subject: FPS2018'OO1O] - 7O0USVVVarnsSt - Madrona Recovery
Hello John,
This is to let you know that the plans examiner,Tom Hochstatter, has asked that we void this permit as fire extinguisher
locations are no longer regulated by the fire code.
No refund will be processed as no fee were paid at time of application submittal.
Thank you.
Dianna L. Howse
Building Division Services Supervisor
City of Tigard Community Development
13125 SW Hall Blvd J Tigard, OR 97223
503-718-2430 Direct I 503-718-2439 Permits
DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail
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